Facing a tough decision SOON. Please help.

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dmc123

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Thanks in advance. (Im desperate as Im sure are most here)
Im starting to feel very skeptical of doctors and cant help to think of them as self serving. I hoping someone here can help me before I do something drastic

The short story:
(44 y/o and athletic)
Over the past 5 years I started having terrible lower back pain episodes. Originally they were brought on by some activity a few times a year and now they come on with even moderate activity. The episodes were mostly some trigger sensation that would worsen over the course of a day to full blown stiffness, pain, spasm and a shift in lateral posture (shoulders to hips). Even after an episode I felt a deep painfull pinpoint spot about 1" of left of the spine at whats been explain to be L4/5
The original MRI 2006 revealed herniations at L3/4, 4/5 and 5/s1 with the one at L4/5 being the worst. Originally I didnt have much or anything in the way of leg pain. (thats changing lately). For a few years the epidurals have worked fine 2x or 3x per year but I heard that they can be dangerous in the long term. I also did a few rounRAB of PT over the years. I toured a few doctors and they all tried a few things in addition to the Epi's even facet blocks and denervations at L4/5 but nothing seemed to last very long. My last epidural was 1.5 years ago. I had a pretty good year until mid summer and then I had episode after episode., some lasting weeks. Ive also started developing some "heaviness" in my shins and feet with some burning in my right buttock. I like to break up the pain by 100%. 70% in my left lower back, 20% in my right buttock and 5% in each leg. I had another MRI and it was a bit worse than the first in terms of the nerve inpingement on the L4/5 nerve root. Well I was referred to a surgeon and since then Ive seen a few. One ordered up a discograph that seems to have showed a positive at L4/5

Here where the problem is. There have been differences of opinion among almost all of the surgeons. Some say do nothing but conversative stuff, some say microdiscetomy/decompression and one said fuse.

Now one of those doctors is giving me such high confidence (90% success) that it sounRAB almost too good to be true and Im thinking of jumping at it. In fact I scheduled it for the 12/22/10 (~3 weeks away). He thinks that micro surgery on the 4/5 disk with facet decompression (spur removal) 4/5 and 5/S1 will do the trick. Now aside from pain management and PT, this sounRAB like the least invasive. Im wondering what the community thinks the risks are in me moving forward with microdiscectomy (since it seems the bone fusion option will always be there). Ive heard of spinal instability and scarring. Im not sure I really understand them as a reason for not moving forward with micro surgery.
 
Hi there,
I am fairly new to this board as well. I have had the same issues with my back as you have. I had two surgical opinions from NS's. I have a ruptured disc herniation at L5-S1, and a disc bulge at L4-5, and minimal findings at L3-4. I have been in pain for 7+ years. The first surgeon said discectomy/laminectomy to remove the 7mm disc herniation at L5-S1. From my research, discectomies are best for people who suffer more from leg pain than back pain. The second opinion I got was from the best NS in Nashville at Vandy and he said because my pain was 90% low back pain, that I should have the fusion. He said the first opinion did not listen to my symptoms. He gave me a 90% success rate as well. I have no (none, natta, etc.) disc space at all at L5,S1..it is completely collapsed. NS referred to it as a black disc, as it was black on the MRI and was basically bone on bone. We are going to do a 2 level fusion as the L4-5 is starting to collapse as well. A lot of people who go for the microdiscectomy are right back on the surgeons table in a matter of months or years. I never want to do this again so I decided to go for the fusion. Having it on 01/12/2011. Keep me posted on what you decide. And do your research, there is a lot of good info out there. I have a great website but, no able to post it here. I hope this helps.
 
Hello dmc, and welcome to the board. First of all, let me say that I am skeptical of any doctor who offers a 90% success rate...especially in light of the fact that you have 3 bad discs. Once a part of the disc at L4-5 is removed, the other discs are going to have to bear more weight, thus speeding up deterioration. Since you also have nerve impingement, I am not sure that the proposed surgery is the right one for you. However, I am NOT a doctor.

Having said that, I think you should spend a lot of time researching about the spine and conditions that you have and try to come to some conclusion in your own head. Have you thought about seeing an Orthopedic Spine Specialist to get an opinion aside from a neurosurgeon's?

No one wants to have surgery, and opting for the least invasive is certainly something to consider, however, it is wise to also look towarRAB the future concerning the deteriorating discs above and below the one that is the main focus. Again, research is the answer in helping with your decision.

Whatever you decide to do, I hope it turns out well for you. I also hope that you will stay in touch with the folks here and let us know how things are going for you or to ask further questions.

Blessings.

Carol
 
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